COPING WITH COGNITIVE DECLINE AMONG OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT OR MILD DEMENTIA: A SCOPING REVIEW

Abstract As cognitive impairment progresses, Persons with Mild Cognitive Impairment or Mild Dementia (PwMCI or MD) have trouble in adapting to changes in their cognitive functioning and, as a result, develop challenges in daily activities. If these challenges are not appropriately addressed, PwMCI or MD can experience poor health outcomes and quality of life. Coping, behavioral and cognitive efforts to regulate the distress from a certain stressful situation, is widely regarded as a fundamental determinant of health outcomes. We conducted a scoping review to understand what coping strategies PwMCI or MD used, and facilitators and barriers of the use of these coping strategies. Using the PRISMA-ScR guideline, we reviewed peer-reviewed empirical studies exploring coping experiences for cognitive impairment among community-dwelling PwMCI or MD. We used thematic synthesis to generate themes relevant to the coping strategies and the facilitators and barriers. Of 1267 studies identified, 12 qualitative studies were reviewed. Under three dimensions of coping strategy (i.e., problem-solving, emotional, and maladaptive coping strategies), six themes were identified: independent coping (e.g., use of reminder and practice of cognitive activities), collaborative/dependent coping (e.g., asking help as needed), reframing, expression of unpleasant feelings, comparing self to others, and avoidance. The themes for facilitators and barriers were social response to one’s cognitive impairment, assistance from informal care partners, and support from professionals. These findings can provide not only a better understanding of how people cope with their cognitive impairment but can also provide rationale for developing interventions to maximize the use of coping strategies.


PREVALENCE AND FACTORS ASSOCIATED WITH MOTORIC COGNITIVE RISK IN A COMMUNITY-DWELLING OLDER SCOTTISH POPULATION
Donncha Mullin 1 , Lucy Stirland 1 , Tom Russ 1 , Michelle Luciano 1 , and Graciela Muniz Terrera 2 , 1. University of Edinburgh,Edinburgh,Scotland,United Kingdom,2. Ohio University,Athens,Ohio,United States Motoric Cognitive Risk (MCR) syndrome combines slow walking and self-reported cognitive complaints. It is a quick and simple way of identifying individuals at high risk of developing dementia. MCR has not been described in a Scottish population to date. This study describes the prevalence and associated factors of MCR in a communitydwelling sample of older Scottish people. The MCR concept was derived in the Lothian Birth Cohort 1936 (LBC1936) -a highly phenotyped cohort of over 1000 people followed up every 3 years since 2004. Uniquely, participants in LBC1936 had their IQ measured at age 11 in 1936. Authors found MCR prevalence of approximately 5.4% at baseline. Using logistic and linear regression analysis, as appropriate, they found that participants' age, depressive symptoms and cognitive measures of executive function were significantly associated with an increased likelihood of have MCR, but that IQ aged 11 was not associated. This study found rates of MCR in Scotland are within the typical range for this age group, albeit on the lower end. Interestingly, IQ at age 11 was not significantly associated with MCR, which was unexpected given MCR's prognostic value for dementia. That tests of executive function were associated with MCR adds further credence to the hypothesis that walking speed and executive function are linked. This points to further important work to ascertain if increasing walking speed can improve executive function.

SEX DIFFERENCES IN THE ASSOCIATION BETWEEN BODY COMPOSITION AND 2-YEAR CHANGE IN COGNITIVE FUNCTION
Daehyun Lee 1 , Miji Kim 2 , Hyung Eun Shin 2 , Jae Young Jang 2 , and Chang Won Won 2 , 1. Kyung Hee Univerisity,Seoul,Republic of Korea,2. Kyung Hee University,Seoul,Republic of Korea In the process of aging, the loss of lean mass and increase in fat mass are associated with cognitive decline. This study investigated sex differences in the association between body composition and changes in cognitive function in community-dwelling older adults in Korea. A total of 1,420 participants (aged 70-84 years, 54.2% men) of the Korean Frailty and Aging Cohort Study with data from baseline and 2-year follow-up surveys were included. Body composition was measured using dual-energy X-ray absorptiometry and cognitive function was assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. The total fat mass was lower in men than in women (p< 0.001), whereas total lean mass was higher in men than in women (p< 0.001). Total body fat mass was positively associated with the time taken to finish the Trail Making Test-A only in women (standardized beta coefficient [ß]= -1.371, p=0.018), and a negative association was observed between trunk fat mass and digit span total only in men (ß= -0.092, p=0.039). Appendicular lean mass was significantly positively associated with word list recognition only in women (ß=0.087, p=0.010) and was significantly positively associated with digit span total (ß=0.108, p=0.027) and digit span forward (ß=0.081, p=0.025) only in men. The results of this study indicated that higher fat mass was associated with the protection of decline in cognitive function only in women, while lean mass was positively associated with a change in cognitive function in both sexes. As cognitive impairment progresses, Persons with Mild Cognitive Impairment or Mild Dementia (PwMCI or MD) have trouble in adapting to changes in their cognitive functioning and, as a result, develop challenges in daily activities. If these challenges are not appropriately addressed, PwMCI or MD can experience poor health outcomes and quality of life. Coping, behavioral and cognitive efforts to regulate the distress from a certain stressful situation, is widely regarded as a fundamental determinant of health outcomes. We conducted a scoping review to understand what coping strategies PwMCI or MD used, and facilitators and barriers of the use of these coping strategies. Using the PRISMA-ScR guideline, we reviewed peer-reviewed empirical studies exploring coping experiences for cognitive impairment among community-dwelling PwMCI or MD. We used thematic synthesis to generate themes relevant to the coping strategies and the facilitators and barriers. Of 1267 studies identified, 12 qualitative studies were reviewed. Under three dimensions of coping strategy (i.e., problem-solving, emotional, and maladaptive coping strategies), six themes were identified: independent coping (e.g., use of reminder and practice of cognitive activities), collaborative/dependent coping (e.g., asking help as needed), reframing, expression of unpleasant feelings, comparing self to others, and avoidance. The themes for facilitators and barriers were social response to one's cognitive impairment, assistance from informal care partners, and support from professionals. These findings can provide not only a better understanding of how people cope with their cognitive impairment but can also provide rationale for developing interventions to maximize the use of coping strategies.

MENTAL-SOMATIC MULTIMORBIDITY IN GROUP-BASED TRAJECTORIES OF COGNITIVE FUNCTION FOR MIDDLE-AGED AND OLDER ADULTS
Siting Chen 1 , Corey Nagel 2 , Anda Botoseneanu 3 , Heather Allore 4 , Jason Newsom 5 , Stephen Thielke 6 , Jeffrey Kaye 1 , and Ana Quiñones 7 , 1. Oregon Health & Science University, Portland, Oregon, United States, 2. University of Arkansas for Medical Sciences,Little Rock,Arkansas,United States,3. University of Michigan Dearborn,Dearborn,Michigan,United States,4. Yale University,Guilfrod,Connecticut,United States,5. Portland State University,Portland,Oregon,United States,6. University of Washington,Seattle,Washington,United States,7. Oregon Health and Science University,Portland,Oregon,United States Somatic and mental multimorbidity contributes to cognitive decline. The study aims to identify distinct trajectories of cognitive performance among middle-aged and older adults, and to examine the contribution of specific somatic and mental multimorbidity combinations on subsequent risk of cognitive impairment. We used group-based trajectory modeling to identify trajectories of cognitive impairment risk among participants in the Health & Retirement Study during years 1998-2016 (N=20,372). We included time-invariant sociodemographic factors (sex, race/ethnicity, education) to quantify their association with trajectory class membership, and time-varying multimorbidity combinations to examine their relative impact on observed trajectories. Four somatic-mental multimorbidity combinations were analyzed: somatic multimorbidity (two or more of the following: heart disease, lung disease, hypertension, arthritis, diabetes, cancer), stroke-multimorbidity (any somatic including stroke); depressive-multimorbidity (any somatic including high depressive symptoms); and stroke and depressive multimorbidity (including both stroke and high depressive symptoms). We identified three trajectory classes of cognitive impairment: low baseline risk with gradual increase (55.1%); low baseline risk with rapid increase (32.8%); and high baseline risk with gradual increase (12.1%). In the group with low baseline risk with rapid increase, stroke-multimorbidity (OR: 2.40, 95%CI: 2.11, 2.74) and depressive-multimorbidity (OR: 1.65, 95%CI: 1.50,1.81) each had higher odds of cognitive impairment relative to somatic multimorbidity. Similarly, stroke and depressive multimorbidity (OR: 3.46,95%CI: 2.85,4.21) was associated with higher odds of cognitive impairment compared with somatic multimorbidity. This study highlights the importance of risk modification for somatic and mental multimorbidity combinations from mid-life to inform interventions to sustain cognitive performance.

PSYCHOSOCIAL WORKING CONDITIONS IN MID-LIFE AND COGNITIVE AND PHYSICAL IMPAIRMENT IN OLDER AGE
Shireen Sindi 1 , Shadi Kiasat 1 , Ingemar Kåreholt 2 , and Charlotta Nilsen 2 , 1. Karolinska Institutet,Solna,Stockholms Lan,Sweden,2. Jönköping University,Jönköping,Jonkopings Lan,Sweden Background: Psychosocial working conditions have been associated with cognitive and physical impairment among older adults. However, less is known on whether psychosocial working conditions are associated with a combination of cognitive and physical impairments. The aim of this study was to investigate the associations between midlife psychosocial working conditions and physical and cognitive impairment among older adults, and to assess whether there are sex differences in these associations.
Methods: The data were derived from two Swedish nationally representative surveys (n=839) with a follow-up time of 20-24 years. Multinomial and binary logistic regressions were used to assess the associations between work stressors according to the job demand-control model, and a combination of cognitive and physical impairment.
Results: Low control jobs were significantly associated with higher odds of both cognitive and physical impairment as well as a combination of cognitive and physical impairment. Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment, and cognitive and physical impairment in combination. Active jobs (high control, high demand) were associated with lower odds of cognitive impairment. Sex-stratified analyses showed stronger associations among men than among women. Among men passive jobs were significantly associated with both cognitive and physical impairment. Low strain jobs were significantly associated with less physical impairment.
Conclusions: These results highlight the importance of midlife psychosocial working conditions for late-life physical and cognitive impairment, and especially among men. Jobs characterised by higher control, lower strain and active jobs may promote resilience and cognitive reserve among older populations.